HomeMy WebLinkAboutX2019-0964 - Permit Application'?rin F rr j Worksheet for Combo Building & Solar Permit Application
Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
,FIBuilding rl, Grading r -!Drainage, F�(Elec
Project Address (Not mailing address
133 t4ew�ut+
Description of Work/! t = (PL A
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New/Add SFF " Remodel SF
Mech j—! Plum Cu Yd cut, Cu Yd Fill
j`i Flood [7! Fire i°' Liq r7 Landslide FIN/A Floor Suite No
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4�" Use ��,j-A'�,�onstType
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# StoriesI # Units (if Res);
Valuation 5
Garage/New/Add —! Material/LaborFO/
0041. 00
OWNER'S NAME Last2v�_Ag ��A� � First
Owner's Address Owner's E-mail Address
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City (2 v`/1 a State ( ZiP 9z lol 7 Telephone1(1'19)7a0
APPLICANT'S NAME Last
First l Mf4 ssa / Tz) l sl �--A!
Applicant's Address Applicant's E-mail Address
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City State
Sav> �e _. S F Zip e � g
5 t (%�0�.� � Telephone
ARCHITECT/DESIGNER'S NAME Last (---_-_ - First (_ ILic No.
Architect/Designees Address Architect/Designer's E-mail Address
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city p ,.. State F Zi F�' Telephoned
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ENGINEER'S NAME Last First F Lic. No.j
Engineer's Address Engineer's E-mail Address
City State F Zip I TelephoneF_�—
CONTRACTOR'S NAME/COMPANY 1 5 1 G rJ 5 Lic. No. it) 9 g pj Class C� 6
Contractor's Address Contractor's E-mail Address
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Ci _ State Zip l� ��Telephonel. ��j, z� 3_(p
SETBACKS REAR SETBACKS FRONT PERMIT NO. l • 0 lul-,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $